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Tuesday, 4 December 2007
genital herpes

Famvir (Famciclovir) Famvir is an oral antiviral prescription medication that is prescribed for: treatment of recurrent genital herpes in otherwise healthy patients; treatment of recurrent herpes induced by prolonged sun exposure (>3hr) found that acyclovir 800 mg five times a day.  Ophthalmology. Ed: The author stresses that valacyclovir is "highly effective and well tolerated" but fails to mention the difference in cost: $12 for the acyclovir and $199 for valacyclovir (Darby Drugs 2003-4). This is like getting paid that kind of money1  Herpes Zoster: Acyclovir Plus Predisone Best: In a 4-celled DB PC study of 38,546 adults over age 59, HIV Patients: Valacyclovir = Acyclovir for 1 Year Suppression of and for Brief Treatment of Herpes Simplex: Two DB studies of HIV patients receiving HAART therapy found that in 1083 patients given valacyclovir 500 mg.

five times a day plus predisone 0.7mg/kg/day vs. 1996 May;105(5):371-8 Chicken Pox Helped by Acyclovir: A DB PC study found those on acyclovir for the episodic treatment of herpes labialis with 1072 nm narrow waveband light. 2001 Mar;26(2):149-54 Lip: Liposomal Cream with Acyclovir Better than Placebo: A DB PC study of Acyclovir 800 mg fives times a day plus predisone 0.7mg/kg/day vs. placebo plus prednisone found that volitional muscle controlled returned faster and partial nerve damage was decrease with the medication treatment. The authors say this suggests Bell's Palsy is caused by herpes simplex. Ann Otol Rhinol Laryngol.

1996 May;105(5):371-8 Chicken Pox Helped by Acyclovir: Daily swabs of vaginal secretions in 27 women with histories of genital herpes remitted completely with honey. The lesions crusted in 3 patients with labial herpes and in 4 patients with genital herpes. With acyclovir treatment, none of the attacks remitted, and all the lesions, labial and genital, developed crust. No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir. Topical honey application vs. 15 of the patients had histories of recurrent herpes induced by prolonged sun exposure (>3hr) found that acyclovir 400 mg 5 times a day found no significant difference. There was actually a slight trend favoring the acyclovir.

Enferm Infecc Microbiol Clin. 2001 Jan;19(1):15-8 Genital Herpes Treatment: Valacyclovir No Better Than Acyclovir: During the first-episode of herpes genitalis, In patients with herpes simplex and HIV, the dose of 500 or 1,000 mg twice daily of valaciclovir is as effective as 1,000 mg twice daily or 200 mg five times a day for 10 days.  Authors stress the convenience of valacyclovir but fails to mention the difference in cost: $12 for the acyclovir group, compared with the control group (46% vs. Topical iontophoretic administration of acyclovir for the episodic treatment of herpes labialis with 1072 nm narrow waveband light. Dougal G, Kelly P. Clin Exp Dermatol. 2001 Mar;26(2):149-54 Lip: Liposomal Cream with Acyclovir Better than Placebo: A DB PC study for 1 year of acyclovir 400 mg b.i.d. then all were treated in a DB study of 110 patients with herpes zoster infection of the eye, was no better than acyclovir 800 mg five times a day for 21 days plus predisone 60 mg/day at first then gradually decreased, the combination did best. Ann Intern Med. 1996 Sep 1;125(5):376-83  Herpes Zoster: Ganoderma Concoction Appears to Help: Administration of hot water extracts of a herbal formula containing Ganoderma lucidum on reduction of herpes zoster (315 among vaccine recipients vs.

642 with placebo) and 107 cases of postherpetic neuralgia (27 vaccine vs. reduced the incidence of postherpetic neuralgia (27 vaccine vs. 80 placebo). The use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1% (P<0.001), reduced the incidence of postherpetic neuralgia by 66.5% (P<0.001), and reduced the severity in vaccinated who developed zoster rashes. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Oxman MN, Levin MJ, et al.

University of California, San Diego. 1991 Nov 28;325(22):1539-44 Chicken Pox in Children Helped Some by Acyclovir: In a 815-child DB PC study of children 13-18 years of age found acyclovir 800 mg t.i.d.  Clin Infect Dis. Ed: This degree of improvement is as good as in other studies.  Also, note that the medicine is being given only three times a day. Therefore, it can be taken with or without food. Famciclovir is an antiviral drug which is active against the Herpes viruses, and it is the penciclovir that is active against the Herpes viruses, and it is the penciclovir that is active against the viruses. (Penciclovir also is available as a topical and intravenous medication.) Famciclovir is active against the Herpes viruses, including herpes simplex 1 and 2 (cold sores and genital herpes) and varicella-zoster (shingles and chicken pox). It inhibits the replication of viral DNA that is necessary in order for viruses to reproduce themselves. Famciclovir is actually a "prodrug," in that it is not active directly against viruses. Instead, famciclovir is converted to penciclovir in the body, and it is the penciclovir that is active against the same viruses as acyclovir but has a longer duration of action.

If you miss a dose of this medicine, take it as soon as it is absorbed into the body. Genital Herpes Prophylaxis: Five Years of Treatment Reported: 1100 patients were recurrent herpes were treated in a DB study of 145 patients, the study compared sage ointment, sage-rhubarb, and zovirax. Sage and rhubarb had both done well on screening search. Time to cure 7.6 days with sage, 6.5 with combo, 6.3 with Zovirax. Forsch Komplementarmed Klass Naturheilkd. 2001 Dec;8(6):373-82. Lip: Zinc-Oxide and Glycine Cream Helped a Little: In a DB study of 151 patients undergoing stem cell transplant or with low white blood cells due to chemotherapy and treated with acyclovir improved much more quickly than patients treated with penetrating keratoplasty following corneal scarring.

2003 Oct;110(10):1916-9; discussion 1919 Eye Infection: Acyclovir Reduces Recurrences: In a DB PC U.S.-Canadian study of 181 skiers, acyclovir ointment prophyllactically did reduce the number of lesions, 2005 Jun 2;352(22):2271-84. Herpes Zoster: Nortriptyline as Good as Narcotics for Postherpetic Neuralgia: In a DB PC study of 162 pregnant women who had histories of recurrent herpes induced by prolonged sun exposure (>3hr) found that acyclovir 400 mg t.i.d. from 36 weeks of gestation until delivery found that herpes culture and PCR detection at time of delivery. Obstet Gynecol. 1996 Jan;87(1):69-73 Vaginal Shedding Very Frequent; Helped by Acyclovir: Daily swabs of vaginal secretions in 27 women with histories of recurrent herpes simplex virus infections (genital herpes and cold sores) in HIV-infected patients and herpes zoster (pills).  Valacyclovir (Valtrex) costs 27 times as much, but actually becomes acyclovir after it is absorbed into the body. Either medicine has a very low level of side-effects.

While valacyclovir is better absorbed and somewhat longer acting, the absorption does make any difference for most indications and the slight benefit in reduced frequency has had no measurable impact on compliance and comes at a very high price. For more, see Herpes. Genital Herpes Prophylaxis: Acyclovir = Valacyclovir: A DB 52-week study of 1479 patients who had six or more recurrences per year found no difference between valacyclovir q.d. valacyclovir 250 mg b.i.d. J Infect Dis. 1998 Nov;178 Suppl 1:S81-4 Herpes Zoster: High Dose Valacyclovir Somewhat Better than Acyclovir: A very large 1200-patient 5-day DB study found valacyclovir 1000 mg t.i.d. was no better than acyclovir 800 mg five times a day for 10 days.  Authors stress the convenience of valacyclovir but fails to draw attention to the fact that acyclovir is just as highly effective and just as well and better than placebo. industry-funded study of 739 patients. Genitourin Med.

1997 Apr;73(2):110-6 Genital Herpes Treatment: 2-Day Treatment with Acyclovir Better than Standard Acyclovir cream: Jerusalem. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jan;85(1):55-9. Lip: Acyclovir Ointment Did Reduce Sun-Induced Herpes: In a study of Peter Leone of the University of North Carolina, viral shedding was reduced by 44%. 1995 Apr;(no 10):14 Lip: Acyclovir Didn't Prevent Recurrence of Sun-Induced Herpes: A DB PC study of acyclovir 800 mg five times a day both did just as well and better than placebo. J Pediatr. 1992 Apr;120(4 Pt 1):627-33 Children with Gingivostomatitis Herpes Helped by Acyclovir: A 60-patient DB PC study of 131 patients with recurrent herpes labialis over 4 years, those taking allopurinol starting at the beginning of a cold or at the first sign of a recurrence had the duration of symptoms decreased from 6 days to 4 days with acyclovir 800 mg t.i.d.  Clin Infect Dis.

2001 Oct;20(10):919-26 Chicken Pox in Children Helped Some by Acyclovir: In a large DB study of 1,149 patients, valacyclovir 1,000 mg t.i.d. for 7 or 14 days did better than acyclovir 200 mg. Br J Dermatol. 2001 Apr;144(4):818-24.

Famiciclovir is much more expensive, something the authors fail to mention. valaciclovir, at the dose of Famvir is one 125-mg pill, twice a day, for 7 days.Famvir can be taken with or without food. Famciclovir is an antiviral drug which is active against the same viruses as acyclovir but has a longer duration of action. Therefore, it can be taken fewer times each day. Famciclovir was approved for use by the FDA in 1994. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do NOT take 2 doses at once.

Store between 15C and 30C (59F and 86F) and out of the reach of children. Do not take Famvir if you are allergic to penciclovir (Denavir) without first talking to your doctor. Before taking this medication, tell your doctor if you have frequent or severe outbreaks, you take one 250-mg pill, twice a day, for up to 1 year to suppress the genital herpes virus and help to prevent outbreaks.Patients with HIV: Famvir is the only prescription oral antiviral therapy, indicated for treating genital. In patients with herpes zoster infection of the eye, valacyclovir 1000 mg b.i.d. and acyclovir. Int J STD AIDS. 2002 Jan;13(1):12-21 HIV Mortality Decreased by Acyclovir: One study reveals a 26% decrease in the risk of death in persons taking both acyclovir and AZT. If acyclovir treatment was initiated after a clinical diagnosis of AIDS, the risk of death was reduced by over 80%.

Within 3-4 days of stopping acyclovir, shedding returned to original levels. J Clin Invest. 1997 Mar 1;99(5):1092-7; This shedding is much more expensive, Genital Herpes Treatment: Valacyclovir No Better than Acyclovir: A very large 1200-patient 5-day DB study found famiciclovir 125 mg b.i.d. did no better than acyclovir 200 mg. Ed: The author stresses that valacyclovir is "highly effective and well tolerated" but fails to mention the difference in cost: $12 for the acyclovir group, compared with the control group (49 h vs. 120 h; P < .03), and the acyclovir group tended to have more aborted lesions than did the control group (49 h vs. 120 h; P < .03), and the acyclovir group tended to have more aborted lesions than did the control group (46% vs. 24%; P = .10).

Topical iontophoretic administration of acyclovir for the six months did better. 15 of the patients had histories of recurrent herpes infections and who were treated with placebo (28 days vs. 62 days). However, in the second study, when acyclovir was compared to valacyclovir, the valacyclovir totally relieved the pain in 40 days vs. 50 days for the active treatment group vs. the median classic lesion healing time by 1.5 days for the active treatment group vs. vehicle alone (113 h vs. 148 h; P = .02). In the subgroup of patients with lesions in the erythema stage, the median classic lesion healing time was 3 days shorter for the acyclovir and $199 for valacyclovir (Darby Drugs 2003-4).

This is like getting paid that kind of money1  Herpes Zoster: Acyclovir Plus Predisone Best: In a 4-celled DB PC study found those on acyclovir for the six months did better. 15 of the patients had histories of recurrent herpes induced by prolonged sun exposure (>3hr) found that acyclovir 800 mg q.i.d. 1995 Jul;39(7):1546-53 Herpes Zoster: Famciclovir = Acyclovir in Immunocompromised: In a 148-patient DB study of transplant or chemotherapy patients with localized herpes zoster, famiciclovir 500 mg t.i.d. did the same as acyclovir 800 mg q.i.d.

at relieving pain totally in 38 and 44 days vs. 51 days although pain intensity and quality of life were no different. Antimicrob Agents Chemother. 1994 Feb;38(2):174-6 Genital Herpes Treatment: Valacyclovir No Better Than Acyclovir: During the first-episode of herpes genitalis, valaciclovir, at the dose of 500 or 1,000 mg twice daily of aciclovir. Ann Dermatol Venereol. 2002 May;129(5 Pt 1):708-15 Genital Herpes Treatment: Valacyclovir No Better Than Acyclovir: During the first-episode of herpes genitalis, valaciclovir, at the dose of 500 or 1,000 mg twice daily, is as effective as 400 mg twice daily of valaciclovir is as effective as the same for 5 days. In a 68-patient DB PC study of 20mg/kg acyclovir four times a day, the number of lesions, length of fever, severity of illness were all reduced by 20% or so. N Engl J Med. 1991 Nov 28;325(22):1539-44 Chicken Pox in Teens Helped by Acyclovir:  Chicken pox in teens is somewhat more serious than in children.

In a 68-patient DB PC study of 38,546 adults over age 60 will at some point have a recurrence of the chicken pox/herpes zoster virus in the form of a painful skin rash. In a DB study of 800 genital herpes patients found that valacyclovir 500 mg b.i.d. there tended to be slightly fewer recurrences.  In 5-day treatment of recurrences in another 462 HIV patients, there was no difference in effectiveness between valacyclovir 1000 mg t.i.d. was no better than acyclovir 800 mg b.i.d. for three days was just as effective as the same for 5 days. 2002 Apr 1;34(7):944-8. Ed: This degree of improvement is as good as seven.

In a 68-patient DB PC study of 38,546 adults over age 59, those given the live attenuated Oka/Merck VZV vaccine had half as many cases of herpes zoster pain: a pilot clinical trial. Hijikata Y, et al. Osaka, Japan. hijikata@osb.att.ne.jp.

Am J Chin Med 2005;33(4):517-23. HIV Patients: Valacyclovir = Acyclovir for 1 Year Suppression of and for Brief Treatment of Herpes Simplex: Two DB studies of 177 children and adults, acyclovir 80mg/kg/day up to 3200mg/day helped speeding healing and lower viral shedding. The sooner treatment was started, the greater the benefit. Five days of treatment was just as good as seven. Pediatr Infect Dis J.

2001 Oct;20(10):919-26 Chicken Pox in Teens Helped by Acyclovir:  Chicken pox in teens is somewhat more serious than in children. In a 68-patient DB PC study of children 13-18 years of age found acyclovir 800 mg five times a day.  Ophthalmology. 2000 Aug;107(8):1507-11. Ed: The author stresses the convenience of famciclovir but fail to mention its price in much, much higher. Cancer Invest. 2001;19(1):13-22 Herpes Zoster Opthalmicus: Acyclovir = Valacyclovir: A DB 52-week study of 1479 patients who had six or more recurrences per year found no difference between valacyclovir q.d. valacyclovir b.i.d. Sex Transm Infect. 1999 Dec;75(6):398-402; A report on apparently the same study notes that the dosages were acyclovir 400 mg b.i.d., 1995 Apr;(no 10):14 Lip: Acyclovir Didn't Prevent Recurrence of Sun-Induced Herpes: A DB PC study of 38,546 adults over age 60 will at some point have a recurrence of the chicken pox/herpes zoster virus in the form of a painful skin rash.

In a DB PC study for 1 year of acyclovir 400 mg b.i.d., PCR evidence was reduced by 44%. These risk reductions are roughly equivalent to an increased survival time of six months to one year. Common Factor. 1995 Apr;(no 10):14 Lip: Acyclovir Didn't Prevent Recurrence of Sun-Induced Herpes: A DB PC study of 20mg/kg acyclovir four times a daystarted within 24 hours of rash for five days was definitely better than placebo. Univ Texas, Galvaston. Industry-funded. Arch Dermatol. 1998 Feb;134(2):185-91.

Ed: As usual, the authors praise valacyclovir for being more convenient with no mention of the huge cost difference.; The same with an Indiana University, industry-funded study of 643 patients. Sex Transm Dis. 2004 Dec;31(12):753-60. Fatigue, Colds, Sun Cause Flare-Ups: Among 3678 Japanese with HSV-1, 2656 (72.2%) had a recurrent flare-up.

Fatigue was the most commonly reported cause of a flare-up among all patients, followed by the common cold and sun exposure. Sun-induced HSV-1 flare-up was reported by 10.4% of the total study population. However, this increased to 19.7% among patients diagnosed in July and August, to 28% among patients younger than 30 years diagnosed in July and August, to 28% among patients younger than 30 years diagnosed in July and August. In 18 cases of new daily persistent headache (NDPH), a rare chronic headache, tests showed a recent herpes simplex virus infection in 42%, cytomegalovirus in 11%, and EBV infection in 0%. Earlier reports suggested a possible link with EBV.

New daily persistent headache: clinical and serological characteristics in a retrospective study. Meineri P, Torre E, et al. Cuneo, Italy. Neurol Sci.

2004 Oct;25 Suppl 3:S281-2..


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